戴芳芳，郑波，郭影，许晓立，郭钰英，李慧

(河北省邢台不孕不育专科医院生殖中心，邢台 054001)

HMG预处理在长效长方案降调节中的应用

戴芳芳，郑波，郭影*，许晓立，郭钰英，李慧

(河北省邢台不孕不育专科医院生殖中心，邢台 054001)

目的探讨人绝经期促性腺激素(HMG)预处理在长效长方案降调节中的应用价值。方法收集2014年1月至2016年6月在本院生殖医学中心采用长效达菲林长方案治疗的IVF-ET患者共254例。按照随机数字表随机分为预处理组(118例)和非预处理组(136例)，预处理组促排卵前给予HMG 75U肌肉注射预处理4 d。比较两组患者促排卵各项指标及妊娠结局。结果两组患者一般资料比较无显著性差异(P>0.05)。预处理组Gn天数、Gn使用总量显著低于非预处理组(P<0.05)；预处理组HCG日孕酮(P)值、HCG日E2值略低于非预处理组，获卵数略少于非预处理组，MⅡ卵数、MⅡ卵率、可用胚胎数及临床妊娠率略高于非预处理组，中度及以上OHSS发生率略低于非预处理组，但均无显著性差异(P>0.05)；预处理组预处理后FSH水平显著高于预处理前及非预处理组，卵泡直径显著大于预处理前及非预处理组(P均<0.05)。结论长效长方案降调节后促排卵前应用HMG预处理可以减少Gn用量、Gn天数，且妊娠率有增高的趋势、OHSS发生率有降低的趋势，提示短时间的HMG预处理可能有利于妊娠结局。

人绝经期促性腺激素； 促性腺激素释放激素激动剂； 黄体生成素； 体外受精-胚胎移植

Objective： To investigate the value of HMG pretreatment in long-acting & long-term protocol of IVF-ET.

Methods： A total of 254 IVF-ET patients with adopting long-term triptorelin acetate(Diphereline)in long protocol in Xingtai Infertility Specialist Hospital from June 2014 to June 2016 were collected.The patients were randomly divided into pretreatment group(118 cases)and non-pretreatment group(136 cases)according to the random number table.The patients in pretreatment group were given HMG 75U i.m.for 4 days before ovulation induction.The indicators of ovulation induction and pregnancy outcomes were compared between the two groups.

Results： There was no significant difference in basic condition between the two groups(P>0.05).The days and total dosage of Gn used in pretreatment group were significantly less than those in non-pretreatment group(P<0.05).The levels of progesterone and E2on HCG day，the number of oocytes retrieved and the OHSS incidence were lower than non-pretreatment group，while the number of MII oocytes and the MII oocyte rate，the number of available embryos and clinical pregnancy rate were higher than non-pretreatment group，but there were no significant differences(allP>0.05).The FSH levels in the pretreatment group were significantly higher，and the follicle diameter was significantly larger than before pretreatment and the non-pretreatment group(allP<0.05).

Conclusions： HMG pretreatment after long-acting & long-term protocol and before ovulation induction can reduce the dosage and days of Gn used，as well as slightly improve pregnancy rate and reduce the incidence of OHSS.It suggests that short-term HMG pretreatment may be beneficial to pregnancy outcomes.

Keywords： HMG； GnRH-a； LH； IVF-ET

(JReprodMed2017，26(10)：1011-1051)

促性腺激素释放激素激动剂(GnRH-a)降调节联合Gn组成的长方案是IVF-ET最常用的促排卵方案，目的是在垂体脱敏的基础上，有计划地应用促排卵药物促进多卵泡同步化发育成熟，并防止早发黄体生成素(LH)峰的出现。但在治疗过程中可能因药物剂量、剂型种类、降调方案的不同以及个体间差异出现垂体轴过度抑制，导致卵巢对Gn敏感性下降，卵母细胞质量下降，子宫内膜发育同步性欠佳，Gn用量增加，时间延长，降低妊娠率等[1-2]。本研究分析长效GnRH-a长方案应用过程中垂体抑制较深，应用HMG预处理的效果，以期为临床提供一定经验和参考。